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. 2015 Aug 19:14:39.
doi: 10.1186/s12904-015-0036-9.

Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000-2011

Yee-Hsin Kao  1 , Jui-Kun Chiang  2
Affiliations

Effect of hospice care on quality indicators of end-of-life care among patients with liver cancer: a national longitudinal population-based study in Taiwan 2000-2011

Yee-Hsin Kao et al. BMC Palliat Care. .

Abstract

Background: Quality of near end-of-life (EOL) care is typically evaluated using six accepted quality indicators (QIs). Research has yet to evaluate the quality of EOL care for liver cancer patients in Taiwan. We evaluated the effect of hospice care on the quality of EOL care for patients with advanced liver cancer.

Methods: Using claims data obtained from the Taiwan National Health Insurance Research Database, we analyzed the QIs of EOL care for patients who died between 2000 and 2011. Logistic regression was performed to identify predictors for QIs of EOL care.

Results: A total of 3092 adult patients died of liver cancer during the study period. The patients were divided into those who received hospice care for a period longer than 1 month (long-H group), shorter than 1 month (short-H group), and not at all (non-H group). There was no significant difference in survival probability among the three groups (p = 0.212). Compared with the non-H group, the long- and short-H groups exhibited a significantly lower risk of being admitted to an intensive care unit (ICU) (odds ratios [ORs] = 0.25 and 0.26, respectively, p < 0.001) and requiring cardiopulmonary resuscitation (CPR) during the final month of life (ORs = 0.21 and 0.09, respectively, p < 0.001). Compared with the non-H group, the short-H group had a higher risk of more than one emergency room (ER) visit, and more than one hospital admission (OR = 1.97, p = 0.003; and OR = 1.56, p = 0.001, respectively), but the long-H group did not differed significantly from the non-H group on these measures.

Conclusions: Patients with liver cancer who received hospice care were less likely to be admitted to ICUs or require CPR compared with those who received no hospice care. A longer duration of hospice care was associated with reduced risks of more than one ER visit and more than one hospital admission. We conclude that EOL cancer care in Taiwan might be improved by implementing policies encouraging early hospice referral programs.

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Figures

Fig. 1
Fig. 1
Study flow chart. Abbreviations: ICD-9-CM, International Classification of Diseases, Ninth Revision, Clinical Modification; CIC, catastrophic illness certificate
Fig. 2
Fig. 2
The Kaplan–Meier estimates of survival curves for advanced liver cancer patients stratified by hospice care. Patients were grouped according to those who received hospice care for longer than 1 month (long-H group), shorter than 1 month (short-H group), and not at all (non-H group)
Fig. 3
Fig. 3
Area under the receiver operating characteristic curve (AUC). AUC was 0.833 for the prediction of receiving one or more indicators among patients with advanced liver cancer in their last month of life
See this image and copyright information in PMC

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